In-hospital Outcomes of Patients with Septic Shock and Underlying Chronic Atrial Fibrillation: A Propensity Matched Analysis from A National Dataset.

INTRODUCTION: Atrial fibrillation (AF) is one of the most common arrhythmias among hospitalized patients. Among patients admitted with septic shock (SS), the new occurrence of atrial fibrillation has been associated with an increase in intensive care unit (ICU) length of stay and in-hospital mortality. This is partially related to further reduction in cardiac output and thus worsening organ perfusion due to atrial fibrillation. However, there is a paucity of research on the outcomes of patients who have underlying chronic AF (UCAF) and then develop SS. This study aimed to identify the clinical characteristics and outcomes of patients with UCAF admitted with SS compared to patients with SS without UCAF. METHODS: This study was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with SS, and these patients were stratified into those with and without UCAF. Propensity matching analyses were performed to compare clinical outcomes and in-hospital mortality between the two groups. RESULTS: A total of 353,422 patients with hospitalization for SS were identified, 5.8% (n = 20,772) of whom had UCAF. After 2:1 propensity matching, 20,719 patients were identified as having SS with UCAF, and 41,438 patients were identified as having SS without UCAF. Patients with SS and UCAF had a higher incidence of ischemic stroke [2.5% versus 2.2%, p = 0.012], length of stay [11.5 days versus 10.9 days, p < 0.001], mean total charges [$154,094 versus $144,037, p < 0.001] compared to those with SS without UCAF. In-hospital mortality was high in both groups, but was slightly higher among those with SS and UCAF than those with SS and no UCAF [34.4% versus 34.1%, p = 0.049]. CONCLUSIONS: This study identified UCAF as an adverse prognosticator for clinical outcomes. Patients with SS and UCAF need to be identified as a higher risk category of SS who will require more intensive management.

Sepsis, Septic Shock, and Differences in Cardiovascular Event Occurrence.

Introduction: Mortality estimates from sepsis and septic shock ranged from 18% to 35% and 40% to 60%, respectively, prior to 2014. Sepsis patients who experience subsequent cardiovascular events have increased mortality; however, data are limited among septic shock patients. This study reports in-hospital mortality, incident cardiovascular events, and cardiovascular procedures among sepsis patients with and without subsequent septic shock. Methods: Patients with a primary diagnosis of sepsis with and without a secondary diagnosis of septic shock were identified from the 2016 and 2017 National Readmissions Database. These patients were then evaluated for the occurrence of cardiovascular events and procedures. Results: A total of 2,127,137 patients were included in the study, with a mean age of 66 years. Twenty percent of patients (n = 420,135) developed subsequent septic shock. In-hospital mortality among patients with a primary diagnosis of sepsis was 5.3%, and it was 31.2% for those with subsequent septic shock. Notable cardiovascular events occurring among sepsis patients with and without subsequent septic shock, respectively, included: acute kidney injury (65.1% vs. 32.8%, P < .0001), acute systolic heart failure (9.8% vs. 5.1%, P < .0001), NSTEMI (8.8% vs. 3.2%, P < .0001), and ischemic stroke (2.3% vs. 0.9%, P < .0001). Similarly, the most common cardiovascular procedures between the two groups were: percutaneous coronary intervention (0.37% vs. 0.20%, P < .0001), intra-aortic balloon pump (0.19% vs. 0.02%, P < .0001), and extracorporeal membrane oxygenation (0.18% vs. 0.01%, P < .0001). Conclusions: Sepsis with subsequent septic shock is associated with an increased frequency of in-hospital cardiovascular events and procedures.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock.

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings' mechanisms to improve outcomes in patients with SS and underlying CHF.

Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock.

BACKGROUND: Pulmonary arterial hypertension (PAH) is associated with increased morbidity and mortality risk. The risk for adverse outcomes in patients with PAH in sepsis or septic shock (SSS) is uncertain. METHODS: Adult patients diagnosed with SSS were identified in the National Readmissions Database over the years 2016-2017. A 2:1 ratio nearest propensity matching method was employed for several demographic, social, and clinical variables. In-hospital outcomes were compared between patients with PAH and those without, using t-test and chi-squared test as appropriate. Patients with cardiogenic shock were excluded. Relevant ICD-10 codes were used, and statistical significance was set at 0.05. RESULTS: A total of 1,134 patients with PAH and sepsis/septic shock were identified, with a mean age of 65 years and 67% identifying as females. Patients with PAH had a higher prevalence of some chronic conditions, including chronic pulmonary disease, renal failure, congestive heart failure, coronary artery disease, obesity, coagulation disease. The prevalence of type 2 diabetes mellitus and alcohol use was lower in this cohort. After matching, patients with PAH and SSS, when compared to those with SSS and without PAH, had an increased occurrence of acute heart failure (24.1% vs. 19.6%, p = 0.003), amongst clinical outcomes. The differences in the occurrence of death, vasopressor use, paroxysmal atrial fibrillation, acute myocardial infarction, acute kidney injury, and stroke outcomes were not statistically different between the two groups. Patients with PAH, however, had a longer hospital stay (13.5 days vs. 10.9 days, p < 0.001) and hospital costs ($164,252 vs. $129,185, p < 0.001). CONCLUSION: Patients with PAH have worse outcomes for acute heart failure in sepsis or septic shock. Other mortality and morbidity outcomes are not statistically different. PAH is also associated with a longer hospital stay and increased hospital costs. These findings should be interpreted recognizing the inclusion of patients with re-admissions and the administrative nature of the database.

Transcarotid versus transthoracic transcatheter aortic valve replacement: A systematic review and meta-analysis.

BACKGROUND: Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on Transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. METHODS: We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2. RESULTS: Sixteen observational studies on Transcarotid TAVR were included in the analysis; 4 studies compared 180 TC-TAVR patients vs 524 TT-TAVR patients. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TT-TAVR patients, the mean age and STS score were 79.7 years and 8.7 respectively. TC-TAVR patients had lower 30-day MACE [7.8 % vs 13.7 %; OR 0.54 (95 % CI 0.29-0.99, P = 0.05)] and major or life-threatening bleeding [4.0 % vs 14.2 %; OR 0.25 (95 % CI 0.09-0.67, P = 0.006)]. There was no significant difference in 30-day: mortality [5.0 % vs 8.6 %; OR 0.61 (95 % CI 0.29-1.30, P = 0.20)], stroke or transient ischemic attack [2.8 % vs 4.0 %; OR 0.65 (95 % CI 0.25-1.73, P = 0.39)] and moderate or severe aortic valve regurgitation [5.0 % vs 4.6 %; OR 1.14. (95 % CI 0.52-2.52, P = 0.75)]. There was a trend towards fewer major vascular complications in TC-TAVR [3.0 % vs 7.8 %; OR 0.42 (95 % CI 0.16-1.12, P = 0.08)]. CONCLUSION: Compared with transthoracic TAVR, TC-TAVR patients had lower odds of 30-day MACE and life-threatening bleeding and no differences in 30-day mortality, stroke or TIA, aortic valve regurgitation.

Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis.

BACKGROUND: In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes. METHODS: We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2. RESULTS: Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71-2.46 p = 0.38) I2 = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60-3.37, P = 0.42) I2 = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40) I2 = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61) I2 = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09-1.67, P = 0.21) I2 = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48-1.65, P = 0.72) I2 = 0 %]. CONCLUSION: There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.

Cardiac POCUS: Another Tool in the Armory.

Introduction: This study assessed the educational impact of hybrid cardiac Point of Care Ultrasonography (POCUS) training in a community-based academic setting. Methods: Internal Medicine and Medicine/Pediatrics residents across all post-graduate years (PGY) at a midwestern medical school under-took a structured hybrid (online and hands-on teaching) model of POCUS training. Anonymous surveys with Likert-type scale responses were administered before and after the curriculum. Questions were categorized into domains to assess the residents' interest in learning POCUS, their understanding of fundamental cardiac ultrasound (US) concepts, and their confidence in its application. The authors used Fisher's Exact and t-test, and estimated odds ratios to gauge the impact of the training to achieve net scores above 0 on each domain. Results: A total of 27 and 26 residents completed the pre-and post-training surveys, respectively. Experience with previous cardiac US use showed a positive skew. The training resulted in a significant increase in both, the understanding of the principles, and the residents' confidence in its application. These findings were most significant amongst PGY 2 and 3 residents. Post-training mean scores were similar across all domains for subgroups of PGY level and previous ultrasound experience. Conclusions: Residents displayed greater understanding of the fundamental cardiac ultrasound concepts with improved confidence levels after implementing a structured hybrid teaching model for POCUS. Future studies with objective assessment tools are needed to gauge the clinical impact of POCUS and its adoption rate in clinical practice to guide a recommendation for its incorporation into the residency curriculum.

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb-Threatening Ischemia.

Background The impact of medical record-based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb-threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) claims-based score, was used to categorize patients into low- (<5), intermediate- (5-15), and high-risk (>15) frailty categories. Primary outcomes were in-hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in-hospital mortality and 6-month major amputation. In both ER and SR cohorts, the intermediate- and high-risk groups were associated with a significantly higher risk of in-hospital mortality (high-risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4-11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4-237.6], P=0.002) and major amputation at 6 months (high-risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5-1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4-2.2], P<0.001) compared with the low-risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in-hospital mortality and 6-month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision-making in patients undergoing revascularization for CLTI.

Burden of Hypertensive Crisis in Patients With End-Stage Kidney Disease on Maintenance Dialysis: Insights From United States Renal Data System Database.

BACKGROUND: There is paucity of information on the incidence, clinical characteristics, admission trends, and outcomes of hypertensive crisis (HTN-C) in patients with end-stage kidney disease (ESKD) who are on maintenance dialysis. METHODS: We conducted a retrospective observational study of HTN-C admissions in patients with end-stage kidney disease using the United States Renal Data System. We identified patients with end-stage kidney disease aged ≥18 years on dialysis and were hospitalized for HTN-C from January 2006 to August 2015. RESULTS: A total of 54 483 patients with end-stage kidney disease were hospitalized for HTN-C during the study period. After study exclusions, 37 214 patients were included in the analysis. A majority of patients were Black, there were more women than men and the South region of the country accounted for a great majority of patients. During the study period, hospitalization rates increased from 1060 per 100 000 beneficiary years to 1821 (Ptrend<0.0001). Overall, in-hospital mortality, 30-day, and 1-year mortality were 0.6%, 2.3%, and 21.8%, respectively, and 30-day readmission rate was 31.1%. During the study period, most study outcomes showed a significant decreasing trend (in-hospital mortality 0.6%-0.5%, 30-day mortality 2.4%-1.9%, 1-year mortality 23.9%-19.7%, Ptrend<0.0001 for all). CONCLUSIONS: Hospitalizations for HTN-C have increased consistently during the decade studied. Although temporal trends showed improving mortality and readmission rates, the absolute rates were still high with 1 in 3 patients readmitted within 30 days and 1 in 5 patients dying within 1 year of index hospitalization.

Hypertension and Cardiovascular Diseases among Electronic and Combustible Cigarette Users.

Introduction: Combustible cigarette use is associated with an increased risk of several cardiovascular diseases; however, less is known about associations between these cardiovascular conditions and electronic cigarette use. Methods: This study investigated relationships between electronic and/or combustible cigarette use and diagnoses of cardiovascular diseases using the National Health Interview Survey from 2014, 2016, 2017, and 2018. Results: Compared to non-users, dual users of electronic and combustible cigarettes had increased likelihood of having prior diagnoses of hypertension (OR 1.660, 95% CI = 1.519-1.814), stroke (OR 2.396, 95% CI = 2.011-2.855), diabetes mellitus (OR 1.219, 95% CI = 1.108-1.341), coronary artery disease (OR 2.211, 95% CI = 1.837-2.660), and myocardial infarction (OR 3.839, 95% CI = 3.232-4.560). Exclusive use of electronic cigarettes was associated with an increased likelihood of having hypertension compared to non-users (OR 1.244, 95% CI = 1.048-1.477). Conclusions: There were no differences in diagnoses of stroke, diabetes mellitus, coronary artery disease, or myocardial infarction among exclusive electronic cigarette users compared to non-users; however, these associations could change as young electronic cigarette users with hypertension age, indicating the need for continued research.

Prevalence of cardiovascular diseases in COVID-19 related mortality in the United States.

BACKGROUND: Several cardiovascular disease (CVD) risk factors and sequelae have been associated with COVID-19. Little is known about the distribution of CVD conditions in COVID-19 related deaths in the US population. METHODS: The public-use dataset by CDC, "Conditions Contributing to COVID-19 Deaths, by State and Age, Provisional 2020-2021", was abstracted as of August 1, 2021. A descriptive analysis was conducted to explore the overall and age-specific prevalence of various CVD and risk factors grouped by pre-specified ICD-10 codes amongst COVID-19 patient deaths. Respective trends over the duration of the pandemic were analyzed using the Mann-Kendall method, including time-periods before and after the introduction of vaccines in January 2021. All time-related analysis was conducted between March 2020 and June 2021. RESULTS: A total of 600,241 COVID-19 related deaths were reported between March 2020 and June 2021. Hypertensive diseases were the most prevalent (19.6%), followed by diabetes (15.9%), ischemic heart disease (IHD;10.9%), heart failure (7.7%), cardiac arrhythmias (7.5%), other diseases of the circulatory system (6.6%), cerebrovascular diseases (5%), and obesity (4.1%). While a significant downward trend was noted for hypertensive diseases over the course of the pandemic, cardiac arrhythmias, heart failure (HF), obesity, and other circulatory system diseases demonstrated a significant upward trend. Since the introduction of vaccines, the trends for heart failure and cardiac arrhythmias remained steady while having demonstrated a significant rise in the pre-vaccination time-period. While obesity and other diseases of the circulatory system predominated (>50%) amongst the CVD burden in the younger population (0-24 years and 25-34 years), the percentage occurrence of cardiac arrhythmias, hypertensive diseases, HF, and IHD increased with age. CONCLUSION: Hypertensive diseases, diabetes, and IHD were the most prevalent cardiovascular conditions amongst COVID-19 related deaths. These patterns varied by age. While the trend for hypertensive diseases declined over the course of the pandemic, cardiac arrhythmias, HF, obesity, and other diseases of the circulatory system demonstrated an upward trend. An important limitation is the source of the data being limited to death certificates.

Effects of Vitamin D Supplementation and 25-Hydroxyvitamin D Levels on the Risk of Atrial Fibrillation.

The effects of vitamin D (Vit-D) deficiency and Vit-D treatment (VDT) on atrial fibrillation (AF) remain inconclusive. This study sought to determine the effects of VDT and nontreatment on AF risk in Vit-D-deficient patients without a previous history of AF. In this nested case-control study, 39,845 individuals with low 25-hydroxy-Vit-D ([25-OH]D) levels (<20 ng/ml) were divided into group-A (untreated, levels ≤20 ng/ml), group-B (treated, levels 21 to 29 ng/ml), and group-C (treated, levels ≥30 ng/ml). The risk of AF was compared utilizing propensity score-weighted Cox proportional hazard models. Among the individuals receiving VDT for ≥6 months, the risk of AF was significantly lower in group-B (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80 to 0.98, p = 0.03] and group-C (HR 0.84, 95% CI 0.73 to 0.0.95, p = 0.007] than in group-A. A subgroup analysis of men >65 years showed individuals with hypertension had a significantly lower risk of AF in group-C than in group-B (HR 0.79, CI 0.65 to 0.94, p = 0.02) and group-A (HR 0.78, CI 0.64 to 0.96, p = 0.012). A similar result was found in men >65 years with diabetes mellitus in group-C compared with group-B (HR 0.69, CI 0.51 to 0.93, p = 0.012) and group-A (HR 0.63, CI 0.47 to 0.84, p = 0.002). In what is, to best of our knowledge, the largest observational study to date of patients with Vit-D deficiency and no previous history of AF, (25-OH)D level of >20 ng/ml with VDT for ≥6 months was associated with a significantly lower risk of AF. Additionally, men >65 years with hypertension or diabetes mellitus had a further decrease in AF risk when the (25-OH)D levels were ≥30 ng/ml.

Atypical Presentation of Coronary Artery Fistula: Case Report and Review of the Literature.

Chest pain is one of the common complaints a patient presents to the healthcare provider. It needs prompt evaluation to determine the cause and origin. Angina occurs when myocardial oxygen demand exceeds oxygen supply; the clinical manifestation is often chest discomfort. Atherosclerotic disease is the major cause of angina. However, several non-atherosclerotic conditions have been studied and reported in the literature that causes angina in rarity. We describe a case of coronary artery fistula (CAF) likely causing angina.

Clinical Outcomes of the Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Stent Versus Standard Drug-Eluting Coronary Stents: A Meta-Analysis.

BACKGROUND: Coronary stent neoatherosclerosis, thrombosis, and restenosis remain significant concerns with new-generation drug-eluting stents (DES). The Dual-Therapy CD34 antibody-covered sirolimus-eluting stent [dual therapy stent (DTS)] is a sirolimus-eluting stent with CD34 antibodies immobilized on its luminal surface to capture circulating endothelial progenitor cells and promote early endothelialization. We conducted a meta-analysis to determine whether the DTS was superior to standard DES. METHODS: We conducted a comprehensive search for controlled randomized and non-randomized studies. We presented data using risk ratios (95% confidence intervals) and measured heterogeneity using Higgins' I2. RESULTS: Five studies with a low risk of bias met the inclusion criteria, with a total of 1884 patients in the DTS and 1819 in standard DES arms. There was no difference between the 2 arms in the following 1-year outcomes: cardiac death [1% vs 0.9% RR 1.13 (95% CI 0.49-2.62) I2 = 0%], target lesion failure [6.2% vs 5.3% RR 1.12 (0.80-1.58) I2 = 0%], target lesion revascularization (TLR) [4.9% vs 3.4% RR 1.40 (0.93-2.10) I2 = 15%], target vessel failure [8.2% vs 6.1% RR 1.24 (0.75-2.04) I2 = 0%], target vessel myocardial infarction [1.1% vs 1.8% RR 0.73 (0.19-2.90) I2 = 62%] and stent thrombosis [0.4% vs 0.6% HR 0.85 (0.27-2.62) I2 = 0%]. However, compared with second-generation DES (EES and ZES), the DTS had significantly higher one-year TLR [5% vs. 3.1% RR 1.58 (1.02-2.46) P = 0.04 I2 = 0%]. CONCLUSION: One-year TLR was significantly higher in the DTS arm compared with second-generation DES. There was no difference in the other 1-year clinical outcomes compared with standard DES.

Clinical Outcomes of Sentinel Cerebral Protection System Use During Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare the clinical outcomes following transcatheter aortic valve replacement (TAVR) with and without the use of the Sentinel Cerebral Protection System (Sentinel CPS). BACKGROUND: Stroke occurs in 2-5% of patients at 30 days after TAVR and increases mortality >3 fold. The Sentinel CPS is the only FDA (Food and Drug Administration) approved cerebral embolic protection device. METHODS: The Cochrane Library, PubMed and Web of Science were searched for relevant studies for inclusion in the meta-analysis. Two authors independently screened and included studies comparing the clinical outcomes after TAVR with and without the Sentinel CPS. Risk of bias was assessed using the Cochrane tools (RoB2.0 and ROBINS-I). RESULTS: Four studies comparing 606 patients undergoing TAVR with Sentinel CPS to 724 without any embolic protection device were included. Sentinel CPS use was associated with lower rates of 30-day mortality [0.8% vs 2.7%; RR 0.34 (95% CI 0.12, 0.92) I2 = 0%], 30-day symptomatic stroke [3.5% vs 6.1%; RR 0.51 (95% CI 0.29, 0.90) I2 = 0] and major or life-threatening bleeding [3.3% vs 6.6%; RR 0.50 (0.26, 0.98) I2 = 16%]. There was no significant difference between the two arms in the incidence of acute kidney injury [0.8% vs 1%; RR 0.85 (95% CI 0.22, 3.24) I2 = 0%] and major vascular complications [5.1% vs 6%; RR 0.74 (0.33, 1.67) I2 = 45%]. CONCLUSION: The results suggest that Sentinel CPS use in TAVR is associated with a lower risk of stroke, mortality and major or life-threatening bleeding at 30 days.

Cardiovascular Outcomes Associated With Adult Electronic Cigarette Use.

Electronic cigarettes (E-Cigs) have been advertised as a safer alternative to smoking. However, E-Cigs use, like smoking, delivers ultra-small aerosol particles, which may be associated with cardiovascular disease. This study aimed to look into the association between E-Cigs use and cardiovascular disease outcomes. The study involved self-reported data from 16,855 participants from the National Health Interview Survey data from years 2014, 2016, 2017, and 2018. Results from the logistic regression analysis report E-Cigs users had higher odds of having myocardial infarction (OR 4.09, 95% CI [1.29, 12.98], P<0.05) when compared to non-users. Dual users had higher odds of myocardial infarction (OR 5.44, 95% CI [2.90, 10.22], P<0.05), stroke (OR 2.32, 95% CI [1.44, 3.74], P<0.05), and coronary artery disease (OR 2.27, 95% CI [1.37, 2.44], P<0.05) when compared to non-users.

Cardiac and Systemic Thrombus Caused by Drug Abuse.

Drug abuse is an increasing concern all over the world especially in the United States. Methamphetamine have been well established to cause elevated body temperature, irregular heartbeat, seizures, and heart disease. We present a case of ventricular thrombus with systemic emboli in a patient with dilated cardiomyopathy after methamphetamine use.

Clinical Outcomes of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Chronic Liver Disease: A Systematic Review and Metaanalysis.

Background: Chronic liver disease increases cardiac surgical risk, with 30-day mortality ranging from 9% to 52% in patients with Child-Pugh class A and C, respectively. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. Methods: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant studies and assessed risk of bias using the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) Cochrane Collaboration tool. Results: Five observational studies with 359 TAVR and 1,872 SAVR patients were included in the analysis. Overall, patients undergoing TAVR had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25, 1.82; I2=61%) than patients receiving SAVR. In propensity score-matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I2=13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I2=31%), and hospital length of stay (10.9 vs 15.7 days; mean difference -6.32; 95% CI -10.28, -2.36; I2=83%) than patients having SAVR. No significant differences between the 2 interventions were detected in the proportion of patients discharged home (65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I2=67%), acute kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I2= 0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized mean difference -0.07; 95% CI -0.29, 0.14; I2=0%). Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR.